齐齐哈尔医学院学报
齊齊哈爾醫學院學報
제제합이의학원학보
JOURNAL OF QIQIHAR MEDICAL COLLEGE
2015年
23期
3493-3494
,共2页
剖宫产全麻%靶控输注%丙泊酚%瑞芬太尼%腰硬联合麻醉
剖宮產全痳%靶控輸註%丙泊酚%瑞芬太尼%腰硬聯閤痳醉
부궁산전마%파공수주%병박분%서분태니%요경연합마취
General anesthesia in Cesarean section%Target -controlled infusion%Propofol%Remifentanil%Combined spinal and epidural anesthesia
目的：比较双通道靶控丙泊酚、瑞芬太尼麻醉与腰硬联合麻醉对剖宫产出生新生儿Apger评分的影响。方法将100例ASAⅠ～Ⅱ级，无妊娠并发症和合并症，择期行剖宫产手术的适龄产妇随机分为丙泊酚、瑞芬太尼全凭静脉麻醉组（Ⅰ组）和腰硬联合麻醉组（Ⅱ组），每组50例。两组在麻醉实施前静脉给予乳酸林格氏液500 ml，术中以乳酸林格氏液500 ml维持，出现血压下降，必要时给予去氧肾上腺素80～120μg，Ⅰ组产妇效应室靶控输注丙泊酚3．3μg／ml、瑞芬太尼6 ng／ml、静注顺式阿曲库铵0．12 mg／kg，诱导1 min后插管，术中维持用靶控泵持续输注丙泊酚、瑞芬太尼，维持最初的效应室浓度不变。Ⅱ组产妇采用腰硬联合阻滞麻醉，穿刺间隙选择L3～4，腰麻剂量0．5％罗哌卡因2．5 ml。记录两组患者入室后、开始手术时、断脐时血压、脉搏、SpO2的变化，胎儿出生后1 min时、5 min时、10 min时Apger评分。结果Ⅰ组产妇血压、心率变化较Ⅱ组平稳，Ⅱ组产妇使用去氧肾上腺素的次数多于Ⅰ组，两组比较差异有统计学意义（P＜0．05）；胎儿出生后1 min时、5 min时、10 min时Apger评分两组比较差异无统计学意义（ P＞0．05）。结论双通道靶控丙泊酚、瑞芬太尼麻醉较腰硬联合麻醉对循环干扰更小，对胎儿出生时出生后Apger评分的影响无差异。
目的：比較雙通道靶控丙泊酚、瑞芬太尼痳醉與腰硬聯閤痳醉對剖宮產齣生新生兒Apger評分的影響。方法將100例ASAⅠ～Ⅱ級，無妊娠併髮癥和閤併癥，擇期行剖宮產手術的適齡產婦隨機分為丙泊酚、瑞芬太尼全憑靜脈痳醉組（Ⅰ組）和腰硬聯閤痳醉組（Ⅱ組），每組50例。兩組在痳醉實施前靜脈給予乳痠林格氏液500 ml，術中以乳痠林格氏液500 ml維持，齣現血壓下降，必要時給予去氧腎上腺素80～120μg，Ⅰ組產婦效應室靶控輸註丙泊酚3．3μg／ml、瑞芬太尼6 ng／ml、靜註順式阿麯庫銨0．12 mg／kg，誘導1 min後插管，術中維持用靶控泵持續輸註丙泊酚、瑞芬太尼，維持最初的效應室濃度不變。Ⅱ組產婦採用腰硬聯閤阻滯痳醉，穿刺間隙選擇L3～4，腰痳劑量0．5％囉哌卡因2．5 ml。記錄兩組患者入室後、開始手術時、斷臍時血壓、脈搏、SpO2的變化，胎兒齣生後1 min時、5 min時、10 min時Apger評分。結果Ⅰ組產婦血壓、心率變化較Ⅱ組平穩，Ⅱ組產婦使用去氧腎上腺素的次數多于Ⅰ組，兩組比較差異有統計學意義（P＜0．05）；胎兒齣生後1 min時、5 min時、10 min時Apger評分兩組比較差異無統計學意義（ P＞0．05）。結論雙通道靶控丙泊酚、瑞芬太尼痳醉較腰硬聯閤痳醉對循環榦擾更小，對胎兒齣生時齣生後Apger評分的影響無差異。
목적：비교쌍통도파공병박분、서분태니마취여요경연합마취대부궁산출생신생인Apger평분적영향。방법장100례ASAⅠ～Ⅱ급，무임신병발증화합병증，택기행부궁산수술적괄령산부수궤분위병박분、서분태니전빙정맥마취조（Ⅰ조）화요경연합마취조（Ⅱ조），매조50례。량조재마취실시전정맥급여유산림격씨액500 ml，술중이유산림격씨액500 ml유지，출현혈압하강，필요시급여거양신상선소80～120μg，Ⅰ조산부효응실파공수주병박분3．3μg／ml、서분태니6 ng／ml、정주순식아곡고안0．12 mg／kg，유도1 min후삽관，술중유지용파공빙지속수주병박분、서분태니，유지최초적효응실농도불변。Ⅱ조산부채용요경연합조체마취，천자간극선택L3～4，요마제량0．5％라고잡인2．5 ml。기록량조환자입실후、개시수술시、단제시혈압、맥박、SpO2적변화，태인출생후1 min시、5 min시、10 min시Apger평분。결과Ⅰ조산부혈압、심솔변화교Ⅱ조평은，Ⅱ조산부사용거양신상선소적차수다우Ⅰ조，량조비교차이유통계학의의（P＜0．05）；태인출생후1 min시、5 min시、10 min시Apger평분량조비교차이무통계학의의（ P＞0．05）。결론쌍통도파공병박분、서분태니마취교요경연합마취대순배간우경소，대태인출생시출생후Apger평분적영향무차이。
Objective To compare the influences of dual -channel target -controlled Propofol and Remifentanil anesthesia and combined Spinal-Epidural Anesthesia on Apger scores of newborn after cesarean section.Methods 100 parturient scheduled cesarean section ( ASA I-II, without any associated complications) women were randomly assigned in two groups ( TCI and CSEA, 50 in each group ) .Parturient of two groups received 500 mL of lactated ringer's solution before anesthesia, and another 500mL for maintenance.80~120μg of phenylephrine were administrated when hypotension being observed.Target concentration of effect compartment of propofol was set to 3.3ug/mL, and remifentanil was set to 6ng/mL in TCI group.In CSEA group, puncture point was L3-4 , and 0.5%ropivacaine 2.5 ml was administrated intrathecally.BP, pulse rate, and SpO2 were documented at the time point of entering OR, operation beginning, and umbilical cord being cut, and Apger Scores were also documented at 1 min, 5 min, and 10 min after birth.Results BP and pulse rate were less fluctuating in TCI group comparing with it in CSEA group (P<0.05).Phenylephrine was less administrated in TCI group comparing in CSEA group (P<0.05).There were no statistically differences on Apger Scores at 1 min, 5 min, and 10 min after birth between the two groups.Conclusions TCI with Propofol and Remifentanil provided more stable hemodynamics than CSEA in cesarean sections, and does not influence Apger Scores after birth.
